Provider Demographics
NPI:1639480502
Name:KEUSCH, LUKE MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:MICHAEL
Last Name:KEUSCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-1203
Mailing Address - Country:US
Mailing Address - Phone:812-738-2287
Mailing Address - Fax:812-738-2287
Practice Address - Street 1:439 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-1203
Practice Address - Country:US
Practice Address - Phone:812-630-0493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011481A122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice